Treatment Policy Estimands for Recurrent Event Data Using Data Collected After Cessation of Randomised Treatment

In the past, many clinical trials have withdrawn subjects from the study when they prematurely stopped their randomised treatment and have therefore only collected 'on-treatment' data. Thus, analyses addressing a treatment policy estimand have been restricted to imputing missing data under assumptions drawn from these data only. Many confirmatory trials are now continuing to collect data from subjects in a study even after they have prematurely discontinued study treatment as this event is irrelevant for the purposes of a treatment policy estimand. However, despite efforts to keep subjects in a trial, some will still choose to withdraw. Recent publications for sensitivity analyses of recurrent event data have focused on the reference-based imputation methods commonly applied to continuous outcomes, where imputation for the missing data for one treatment arm is based on the observed outcomes in another arm. However, the existence of data from subjects who have prematurely discontinued treatment but remained in the study has now raised the opportunity to use this 'off-treatment' data to impute the missing data for subjects who withdraw, potentially allowing more plausible assumptions for the missing post-study-withdrawal data than reference-based approaches. In this paper, we introduce a new imputation method for recurrent event data in which the missing post-study-withdrawal event rate for a particular subject is assumed to reflect that observed from subjects during the off-treatment period. The method is illustrated in a trial in chronic obstructive pulmonary disease (COPD) where the primary endpoint was the rate of exacerbations, analysed using a negative binomial model.